AEROBICS

DOC WHAT IS AEROBICS?

Accordingly, aerobics is defined as “a method of physical exercise for producing beneficial changes in the respiratory and circulatory systems by activities which require meeting a modest increase of oxygen intake and so can be maintained."

Because of today’s many new illnesses (hypertension, type 2 diabetes, and other cardiovascular conditions) brought about by modern man’s generally inactive physical lifestyle, experts strongly recommend aerobics for everyone.

Aerobic exercise

The common definition of aerobics is simply the activity that consists of low-intensity repetitive motions of mostly the large muscles of the arms and legs for a period of time. This activity increases breathing and heart rate.

Most low-intensity activities you do during the day also fall under this category. It includes such regular activities as walking, jogging, swimming, and cycling.

For individuals who are beginners in exercise programs, or maybe have histories of health conditions, light exercise routines are recommended at first on most days of the week.

Cardiovascular benefits

Experts advise that these aerobic exercises have to be performed at moderate intensity. This level of activity is safe for almost everyone, and it still provides the desired health benefits.

Recent research brings in additional good news. It is revealed that aerobics performers can still have cardiovascular benefits even if the exercise routine (usually 30 minutes total) is broken into three or four 8-10 minute segments, as long as they are of the same intensity.

Intensity

Doctors, however, discourage infrequent bouts of high-intensity aerobics routines. It is found that this approach is not very healthy.

In the first place, reduction in risks of hypertension, high cholesterol, type 2 diabetes and other conditions depends on the total volume of the exercise done, rather than on intensity.

Higher intensity exercise activities raise your chances for muscle or joint injury. Worse, it may trigger fatal consequences because of heart rhythm disturbances.

Aerobics instructors always begin their sessions with light stretching and low-intensity movements for about 5 to 10 minutes. This warm-up routine is important to avoid injury. At the end of the routine, a similar cooling-down period for about 5 to 10 minutes is also done.

Benefits

As had been proven these years, people who engaged in regular aerobics have been known to benefit by way of lower blood cholesterol counts, lower blood pressure, toned body because of fat reduction and beneficial weight loss.

They have been known to have developed muscular and overall body endurance, have a happier disposition and moods, and a medically-certified general lower risk to cardiovascular diseases.

Common activities

The best part is the easy way on how to do your aerobics, even without going to the gym and participating in gym routines.

Doctors recommend a simple walk that totals around 10,000 steps a day. Start with something lower, and add the number of steps slowly everyday until you reach your goal.

Done on a regular basis, brisk walking is guaranteed to erase your common health risks. Your need for aerobics is not be that hard to fill up.

HYPNOTHERAPY

DOC WHAT IS HYPNOTHERAPY?

Hypnotherapy is the use of hypnosis to treat patients who are in pain or who are having problems within their minds.

The word Hypnotherapy is based off the word "Hypnos," and this was the name of the Greek god of sleep.

Those who use hypnotherapy believe that patients who enter a trance are much more likely to listen to suggestions which are given to them.

Some conditions which are treated by hypnotherapy are
1.pain,
2.stress,
3.obesity,
4.smoking,  
5.amnesia.
6.hysteria

While many of these conditions are related to the mind, some functional ailments can be treated as well.

Hypnotherapy is a practice that was started by the Ancient Egyptians and Indians. Here the practice would often have a religious tone, and both music and dance was included in the practice.

It wasn't until the 19th century that a number of healers begin developing the methods that would come to be known as hypnosis. Franz Anton Mesmer developed a theory which has come to be known as animal magnetism.

He did extensive research on hysteria, and his studies indicated that advanced cases were similar to what is called a post-traumatic stress disorder.

The work of Sigmund Freud also played an important role in the development of hypnotherapy.

A number of criticisms have been made against the practice:

1.Some believe that the connection between the patient and the therapist may cause problems.

2.The patient may want to please the therapist, or they may worry that the therapist doesn't like them.

However, many of these claims are inconsistent because clinical hypnotherapy will generally take place in a medical facility.

There are a number of common techniques that are used in this practice.
1.Regression method-One of the primary techniques is age regression. The hypnotist will attempt to mentally return the patient to a previous state, and this will often be done to help the patient gain something that they have lost.

2.Revivification -the second technique that is commonly used in hypnotherapy is called revivification. In this technique, the hypnotist will help the patient remember previous experiences they've had. As an example, the hypnotist may ask a patient if they have ever been fishing, and if they have been, they will begin recalling the time that they went fishing, and there will be no need for the hynotist to create a new state.

3.Guided Imagery -another common method that is used in hypnotherapy is called a guided imagery. With this technique, the hypnotist will guide the patient through a pleasant experience.

4.Repetition method-The hypnotist may often repeat certain ideas or concepts in order to get the patient to accept them, and this is called repetition.

In general, people are more relaxed when they are in a dream state. When a person is able to visualize something they desire, research has shown that it is much more likely that they will obtain it.

In this situation, the goal of the hypnotist is to help the patient achieve a desired goal.

This technique has primarily been used to help people on a mental level since the 19th century.

MAJOR COSMETIC SURGERY

DOC WHAT ARE THE MORE MAJOR COSMETIC SURGERIES AND PROCEDURES

Major Cosmetic Surgeries which has some risks:
1.Facelifts for patients with wrinkles, excess folds of skin over jaw and neck.
During a facelift operation the wrinkles and excess skin  are eliminated by by tightening of the skin pulling it upwards and backwards.The purpose of the surgery is to give the patient a natural face tension and smooth skin without excess skin under the jaws and neck.Complications to this surgery include bleeding and infection, damage to the facial nerve .Incisions are hidden within the hairline and in front of the ear.
A normal facelift can last for 5 to 10 years.However not all wrinkles can be eliminated.

2.Eyelid surgery such as double eyelids, removal of bags under the eye and drooping eyelids:
Double eyelids operations are done by incision(cut) under local anesthesia of the skin of eyelid, excess fat is removed and the upper eyelid muscle(levator palpebae superior) is attached to the upper eyelid skin to simulate a natural fold. The result is an eye that look brighter and more awake.
Drooping eyelids are due to stretching of upper eyelid skin as a result of aging.
Removal of the excess skin and any excess fat tissue through an incision of the upper eyelid under local anesthesia will tighten the upper eyelid and prevent drooping.
Bags under the eyes is due mainly to aging with congestion of blood, water and fat under the eye as well as looseness of the lower eyelid. They make a person look tired, sad and old. Excess fat, skin is removed through an incision very close to the margin of the lower eye under local anesthesia.
Recurrence of all 3 conditions can occur after a few years.

3.Nose operation includes reduction of large nose or augmenting a flat nose.
Reduction Rhinoplasty: here the nose is too large,so the operation require dissection of the nasal bone with fine saws and reduction of cartilage under general anesthesia to give the desired shape.
Augmentation Rhinoplasty:The nose is too small, the bridge is too low or the tip is too short .The best way to reshape the nose is with a silicone implant tto alter the shape of the nose aand lift the bridge and tip of nose.This is done under local anesthesia through incision through the nostril so there is no obvious scar.

4.Reduction of bat ears which are sticking out can be done by reshaping the abnormal  ear cartilage and the ear folded backwards until it is parallel to the side of the face. This is done under local anesthesia and usually done for children before going to school.

5.Chin and neck problem can be either protruding too much forward or too far backwards.  Where there is no problem with teeth alignment, treatment is easier with reshaping of the front of the jaw bone.
In cases where the jaw is too short, the shape of the jaw can be corrected with a silicone implant through a small incision inside the mouth.
Where there is problem with teeh alignment, the jaw may be required to be shortened and the teeth realigned. This usually requred the services of a specialist dental surgeon.
Double chin patients usually have too much fat and skin under the neck. The fat and can be removed through a small incision in the neck under local anesthesia and the excess skin can also be removed easily by surgery.

6.The breasts can be either too small or too big.
Augmentation surgery usually involve the insertion of a silicone or saline prosthesis into the space between the breast and the chest wall through an incision under the breast.
Reduction of large breast is done under general anesthesia in hospital with removal of excess breast tissue and transplant of the nipple higher to a normal position.

7.Spare tyre may be in the form of excess fatty tissue and loose skin.
The commonest area is in the bulging abdomen especially in the elderly and in women with several pregnancies. The commonest way to remove excess fat is by liposuction which is done under general anesthesia to suck out most of the fat tissues in the abdominal area, thighs, hips or buttocks.The fat is often softened with saline or liquefying agent.
In cases where there is excessive loosness of the skin some surgery may be needed to remove the excess skin and tighten the muscles of the abdomen.

8.Collagen and botox injections: Collagen injections are used to fill up the depression of scar tissue or deep wrinkles. They are also used to tighten the sphincter of urinary tracts or anus in incontinence cases.
Botox injections are used to numb the nerves of the skin so that the muscles of the skin do not tighten to cause wrinkles.

HEALTH EDUCATION

THE IMPORTANCE OF HEALTH EDUCATION AS AN INTEGRAL PART OF PRIMARY HEALTH CARE

by Kenneth Kee 1993

A Dissertation Presented in Partial Fulfilment of the Requirements for the Degree of Doctorate of Philosophy with a Major in Health Care Administration and approved in 1993

ABSTRACT OF DISSERTATION:

This paper examines how health education and promotion forms an integral part of the Primary Health Care System.

It also shows how the concept of health has changed from its original definition by the World Health Organization as a state of complete physical, mental and social well being and not merely the absence of of disease and infirmity to something more realistic, dynamic and measurable.

The original definition has been described as an ideal state which is rarely attainable in real life.

The definition of of health care has also changed from a hospital based curative medicine to one of Primary Health Care and Preventive Medicine.

Primary Health Care is emphasized as the cornerstone of all good health care systems.

The escalating cost of health care associated with high technology and hospital based medicine in the treatment and rehabilitation of chronic diseases has led to the realization among many health care providers that many of the risk factors in the chronic diseases can be prevented at the Primary health care level.

A more rational approach to the current health may require more of a preventable rather than a curative approach in medical treatment.

To this end health education and promotion has proved its importance in the fight against disease and form an integral part of the health care system.

This paper also examines some well known models of health education and promotion such as the Tanahill's model of identifying key groups and their roles in health education and the Green's Proceed-Precede planning framework which identifies various behavioral and environmental factors affecting health.

It recommends various strategies for the [promotion of health such as formulation of definite goals, intersectional collaboration in health education and community participation in health education and community participation.

This dissertation about health education has brought me more knowledge about health issues than 20 years of practice in the field of primary health care.

It has focused my mind on the very important field of preventive medicine and health education.

It has made me more determined than ever to continue my work as a health educator as well as a medical practitioner

It has made me even more aware of the need of continuous medical education to keep abreast of the latest advances in medicine.

Unless I continuously update my medical knowledge I will not be able to explain the latest medical advance to my patient.

Lastly I must always remember that it is the patient who will benefit from my knowledge and that knowledge is not to be kept but to be imparted.

In the words of Professor Rosalind Miller:

"it is a society with myopic vision that foster episodic medical care than health care that includes Primary prevention particularly for those at greatest risk and where social welfare and health problems are indispensable"

PRIMARY HEALTH CARE

IMPORTANCE OF PRIMARY HEALTH CARE IN SINGAPORE

by Kenneth Kee 1991

A Dissertation Presented in Partial Fulfilment of the Requirements for the Degree of Master of Science with a Major in Health Management and approved in 1991

ABSTRACT OF DISSERTATION

Health care is divided into:

1.Primary Health Care (Government Outpatient Doctors, General Practitioners)

2.Secondary Health Care ( Specialist Doctors and Clinics)

3.Tertiary Health Care (Hospital Doctors and Institutional Clinics)

In the past, secondary and tertiary health care have always been the most important agenda in the Singapore Government Health Care Plan.

There has upgrading of specialist clinics and hospitals in Singapore.

In stark contrast the Primary Health Care sector has remained rather stagnant and even comparatively underdeveloped.

Perhaps this is because hospital and specialist health care carry a glamor about it unlike the Primary Health Care doctor who works in the community outsides the confines of the hospital setting.

It is therefore important that the Primary Health Care should be emphasized as the foundation of any good Health Care System.

Unlike the specialist and hospital medicine which represents only the tip of the iceberg of morbidity in a whole community, Primary Health Care covers the whole spectrum of undifferentiated illnesses with its continuing care and management of the whole person from infancy to death.

The WHO at the Alma Ata conference has adopted the objective of "Health For All" which is a rallying call to the international community to enable attainment by all the citizens of the world of a level of health that will permit them to lead a socially and economically productive life.

"Primary Health Care address the main health problems in the community providing promotive, preventive, curative and rehabilitative services accordingly.Since these services reflect and evolve from the economic conditions and social values of the country and community but will include at least:
promotion of proper nutrition and adequate supply of safe water,
basic sanitation,
maternal and child care including family planning,
immunization against the major infectious illnesses.
prevention and control of local endemic diseases,
education concerning prevailing health problems and the methods of preventing and controlling them,
and appropriate treatment of common diseases and injuries."

REIKI

DOC WHAT IS REIKI

Reiki developed in 1922 by Japanese Buddhist Mikao Usui is a form  of complementary and alternative medicine using palm healing to transfer healing energy in the form of ki through the palms.

There are two main forms of Reiki:
1.Traditional Japanese Reiki
2.Western Reiki.

Reiki teachings claim that Reiki is inexhaustible and that it can be used to induce a healing effect.

Within both forms of Reiki, there are three forms of degrees:
1.The first degree Reiki course teaches the basic theories and procedures.
Students learn hand placement positions on the recipient's body that are thought to be most conducive to the process in a whole body treatment.
Having completed the first degree course, a Reiki practitioner can then treat himself and others with Reiki.

2.In the second degree Reiki course, the student learns the use of a number of symbols that are said to enhance the strength and distance over which Reiki can be exerted.

Having completed the second level, the student can work without being physically present with the recipient - a practise known as distant healing.

Students in Japan sometimes only attained the Second Degree after a period of 10, sometimes 20, years of practice.

3.Through the third degree, or "master training", the student becomes a Reiki Master.
The new Reiki Master can attune other people to Reiki and teach the three degrees.
The duration of the master training can be anything from a day to a year or more, depending on the school and philosophy of the Reiki Master giving the training.

There are commonly two types of Master:
Master Teacher  -a Master Teacher is a Master of Reiki and also has the ability teach Reiki
Master Practitioner - Master Practitioner is a Master of Reiki but does not teach Reiki.

Practice
The seven major chakras.
A schematic diagram of the human body's meridians.

In Western Reiki, it is taught that Reiki works in conjunction with the meridian energy lines and chakras through the use of the hand-positions, which normally correspond to the seven major chakras on the body. These hand-positions are used both on the front and back of the body, and can include specific areas

Healing
The Reiki practitioner touched the diseased parts of the body, he massaged them, tapped them lightly, stroked them, blew on them, fixed his gaze upon them for two to three minutes, and specifically gave them energy, and used a technique commonly referred to as palm healing

Whole body treatment
The Reiki practitioner instructs the recipient to lie down, usually on a massage table, and relax. Loose, comfortable clothing is usually worn during the treatment.

The treatment proceeds with the practitioner placing the hands on the recipient in various positions.
However, practitioners may use a non-touching technique, where the hands are held a few centimetres away from the recipient's body for some or all of the positions.
The hands are usually kept in a position for three to five minutes before moving to the next position.
Overall, the hand positions usually give a general coverage of the head, the front and back of the torso, the knees, and feet.
Between 12 and 20 positions are used, with the whole treatment lasting anywhere from 45 to 90 minutes.

Many Western practitioners use a common fixed set of 12 hand positions,

The use of the 12 hand positions energise on many levels by,

1.physical level through the warmth of the hands,
2.mental level through the use of the Reiki symbols,
3.emotional level through the love that flows with the use of the symbols,
4.energetic level though the presence of the Reiki practitioner as well as the Reiki power itself.

The recipient often feels warmth or tingling in the area being treated, even when a non-touching approach is being used.

A state of deep relaxation, combined with a general feeling of well-being, is usually the most common immediate effect of the treatment although emotional releases do occur.

The Reiki treatment is believed to stimulate the body's natural healing processes.

In a 2008 systematic review of randomised clinical trials assessing the evidence basis of Reiki,there is no proof Reiki had been effective for any condition.

SEXUAL HEALTH

DOC WHAT IS SEXUAL HEALTH?

Sex is the need for intimacy ,affection and emotional bond between a man and woman.

It is not just a physical relationship between 2 persons but an emotional tie between the two people called love.

A person's hunger for affection, intimacy, and emotional bond with another person is limitless.

Sexual health refers not only to reproductive sex and organs, but also the physical, emotional and social aspects of the sex act.

It is important to have a positive and respectful approach to sexuality and sexual relationships.

Any couple who has sexual health also feels well emotionally, mentally and socially when talking about sexual matters.

Here are some ways to achieve sexual health:

1. Understand sexuality

Sexuality is defined by the attitudes and values of a couple regarding sexual matters.

It represents a range of issues - from sexual thoughts and actions, to gender identity and roles.

Many factors,from biological,economic,and psychological factors, to social, ethical and religious ones.make up the complete entity of sexual attraction between a couple.

2. Understand that every one have sexual rights

The laws protect every person against sexual violations and discrimination.

Every person have the right to choose whether to be sexually active or not, and  have control over whom he/she wish to have sex with and how it is done.

3. Understand the partner’s sexuality

Because everyone is different, he/she have attitudes, feelings and desires that are different from his/her partner.

Once both partners understand and respect each other’s sexuality, he or she can improve their sexual health and pleasure.

It is therefore important to communicate each person's views to his or her partner and vice versa.

Once a person share what he or she is comfortable with and what he or she want in sex, they are both better prepared for sex.

4. Develop a healthy self-esteem for each other

A healthy self-esteem means to feel good about each other and be comfortable with whom each other are.

If every partner in a sexual relationship have a healthy self-esteem, the acceptance and enjoyment in each other’s presence is increased.

On the other hand, poor self-esteem often leads to unhealthy or even abusive relationships.

5.Always practice safe sex

Sexually Transmitted Infections (STIs) are contracted during unprotected sex and their symptoms vary widely.

The risk of contactiing STI is by practising safe sex, through the use of condoms.

Condoms however do not offer 100% protection so the best option is for a couple to be in a monogamous and faithful relationship.

With no fear of contracting STIs, the couple can relax and enjoy a pleasurable, healthy sexual relationship.

Some common STIs are:

HIV, the virus that causes AIDS

Chlamydia

Gonorrhoea

Herpes

Syphilis

Genital warts

It is important to treat STIs early to reduce complications and stop the spread of infection to others. Some STIs can be cured, while for AIDS, there is no cure.

6. Reproductive health is part of sexual health

Sexual health includes being able to have children, and planning when to have them.

Checkups on reproductive health means a regular visit to the gynaecologist.

Family planning is important so that the couple will never have to deal with an unwanted pregnancy or about passing an infection to the child.

7. Children should be educated about sexual health

There has been an increase in cases of teenage sex in the past few years.

This has resulted in a rise in unwanted pregnancies, abortions and STIs.

Being a parent it is important to keep the children safe from such consequences by educating them on sexual health.

It is important to start when they are young and just beginning to form their values and attitudes towards sex.

In summary, to be in good sexual health, the couple must pay attention not only to physical health.

Mental, emotional, spiritual and sexual health are equally important to achieve overall sexual health.

A Family Doctor's Tale - LARYNGOPHARYNGEAL REFLUX

DOC I HAVE LARYNGOPHARYNGEAL REFLUX

Laryngopharyngeal reflux disease (LPR) is a chronic disease of the pharynx (throat) and larynx (voice box) whose mucosa is damaged by abnormal acid backflow (reflux) of gastric acid from the stomach to the esophagus.

The following causes are responsible for LPR:
There are 2 sphincter muscles in the esophagus:
1.the Lower Esophageal sphincter (LES) prevents the backflow of food and acid from the stomach and acid from the stomach into the esophagus

2.the Upper esophageal sphincter (UES) prevents the food and acid from backflowing into the larynx

An incompetant Lower Esophageal Sphincter(LES) allow the acid and gastric juice to reflux up the esophagus giving rise to gastroesophageal reflux disease or GERD.

If the acid and digestive enzymes from the stomach back flows into the larynx then the condition is called laryngopharyngeal reflux or LPR.

An incompetant lower esophageal sphincter may also result from:
1.Hiatus hernia - hole in diaphragm separating esophagus from stomach is enlarged allowing the easier flow of acid up the esophagus

2.Obesity and pregnancy: increased body weight cause pressure in the abdomen to push gastric contents upwards towards esophagus

The most common symptoms are
1.frequent throat clearing

2.throat itchiness

3.sensation of something in the throat

4.excess phlegm in the throat

5.hoarseness- due to inflammation of the vocal cords from the acid reflux

6.frequent sore throat

7.chronic cough - the acid flow up the esophagus can irritate the larynx and spark off the cough reflex

8.Heartburn - there is a burning discomfort behind the breastbone due to acid flow up the esophagus

Diagnosis:
A detailed history of acid reflux into the larynx and pharynx

Useful investigations may include
1.barium swallow X-rays to check the flow a barium dye from the oral cavity down the esophagus to the stomach. It can detect any reflux of the dye into the esophagus and the presence of any growths in the esophagus and stomach.

2.nasoendoscopy - an endoscope is passed through the nose to the level of voice box in the throat under local anethesia to check on the vocal cords

3.24-hour esophageal pH monitoring - measures the acidity of the esophagus

4.Esophagogastroduodenoscopy (EGD) involves insertion of a thin scope through the mouth and throat into the esophagus and stomach in order to assess the internal surfaces of the esophagus, stomach, and duodenum.

Treatment is aimed at
A. prevention of reflux:
1.weight loss for the Obese

2.Positional therapy
a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients

b.Elevating the head of the bed is also effective.
The head of the bed can be raised by wooden bed risers that support bed posts or legs.
Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.

c.a bed wedge pillow will also help to raise the patient's body higher

3.Certain foods should be avoided to prevent Laryngopharyngeal reflux:
a.Coffee,


b.alcohol,


c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C


d.Antacids based on calcium carbonate actually increase the acidity of the stomach.


e.Foods high in fats -delay stomach emptying


f.Carbonated soft drinks with or without sugar.


g.Chocolate and peppermint.


h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.


i.Milk and milk-based products containing calcium and fat,


j.Eating within 2 hours before bedtime.

k.Large meals- smaller meals reduces reflux as it means there is less food in the stomach at any one time.

4.Smoking reduce lower esophageal sphincter competence, and should be avoided

5.Avoid stress.
Learn to relax or meditate.
Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

B. Neutralizing the Gastric Acid Reflux
1. Drug treatment
a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)

b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)

c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.

d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.

2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.
The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:
a.The Endocinch apply stitches in the LES to help strengthen the muscle.

b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.

c.The Plicator creates a plication, or fold, of tissue near the Laryngopharyngeal junction, and fix the fold using a suture-based implant.

Prognosis:
It is a chronic disease so treatment is lifelong and recurrences are common.

Prevention:
1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar
2.Spicy foods -Cut back on pepper or chilies.
3.Avoid lying down for two to three hours after meals.
When you are sitting up, gravity helps drain food and stomach acid into your stomach.
4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.
5.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.
6.Eat smaller meals to avoid triggering reflux symptoms.
7.Avoid stress.
Learn to relax or meditate.
8.Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

A Family Doctor's Tale - EARLOBE INFECTION

DOC I HAVE A EARLOBE INFECTION

The earlobe or pinna is the outer lobe of the ear which help to protect the ear canal.


Infection can affect the earlobe which is made up of cartilage covered by skin,                                  


Earlobes can be of different sizes and fleshiness.


Some earlobes may be deformed as a result of earlobe infection leading to cauliflower ears.

Causes of earlobe infections are:
1.normal bacteria resides on the skin of the pinna or earlobe.
When the skin is broken as a result of
a.tears of the skin from scratching


b.injury of the skin


c.multiple earlobe piercing


the normal bacteria residing on the skin of the earlobe will infect the skin and the underlying cartilage.


If the cartilage is involved the condition is called perichondritis.


Sometimes the infection is severe enough to destroy the cartilage and cause an abscess.


Infection of the external ear canal may also spread to the pinna.

Symptoms of earlobe infections:
The infected earlobe is usually:
1.red
2.swollen
3.warm to touch
4.extremely painful especially to touch
5.Fever and chills in some cases

Diagnosis of earlobe infections:
1.The diagnosis is usually obvious from the history and physical examination.

2.A swab of the pus may be obtained for test and sensitivity to antibiotics

The Treatment for Earlobe infection:
Earlobe infections caused by bacterial infections are treated with 1.antibiotics both orally and topically


2.analgesics for pain

If the infection progress to an abscess formation, incision and drainage of the abscess may need to be done as well as daily cleansing and dressing.

The abscess may destroy the underlying cartilage and as it heals new cartilage growth may lead to a deformity called the cauliflower ear.

Prognosis of earlobe infections:
All earlobe infections normally will heal but recurrences are common.

Prevention of earlobe infections:
1.avoid unhygienic ear piercing


2.avoid wearing multiple ear rings


3.avoid scratching the skin of the earlobe too hrad because the skin is generally thin over the earlobe region.

What are complications of ear infections?
---------------------------------------------

Most external ear infections can be treated easily and resolved without any damage to the surrounding tissues.
In Otitis Media,there is danger of spread of the infections to the surrounding bone tissue,labrynth, meninges and brain.
Acute mastoiditis
labrynthitis
Meningitis
Brain abscess
Facial palsy
Deafness

A Family Doctor's Tale - CANCER OF VULVA

DOC I HAVE CANCER OF THE VULVA

Cancer of the vulva is  a rare cancer in women which affects the vulva occurring usually in older women past menopause.

The average age is over 60.

The cancer is usually a squamous carcinoma.

Rare tumors are melanoma, basal cell carcinoma and sarcoma.

The most common site is the labium majus(side wall of the vulva) , followed by the clithoris but it may arise anywhere including the urethral area.

The cancer can spread locally to involve the whole vulva and invade the vagina.

Secondary spread of the cancer is along the lymphatic system.

The symptoms and signs of  cancer of the vulva are:

1.The cancer is usually symptomless until it ulcerates.

2.It can presents as a lump which is cauliflower in appearance or ulcerated or indurated.

3.inguinal lymph nodes may be enlarged in cases of spread.

4.There may be pain with ulceration or long standing itch.

Diagnosis of cancer of the vulva is by:

1.Physical examination may revealed a lump or more in the vulva region.

2.Biopsy of the lump may reveal cancer

3.Ultrasound may be able to detect any spread to the vagina, uterus or lymph gland.

The treatment of Cancer of the vulva is  :

1.Surgery:
If there is no evidence of spread, usually removal of the cancerous lump is sufficient.

If the evidence of spread to the entire vulva region, radical vulvectomy may be done together with removal of the inguinal lymph nodes.

Chemotherapy:
Chemotherapy may help to prevent the spread of the cancer or to prevent a reccurance.

Radiotherapy :
Radiotherapy is not a treatment of choice


Squamous cell carcinoma is relatively resistant to radiotherapy.


The vulval skin is also very sensitive the burning effect of radiotheray.


However in the very old and frail patients, radiotherapy may be considered as an alternative to multilating operation.

Prognosis of cancer of the vulva is:
If the lymph nodes are not involved, there is a chance of 70% 5 year cure rate.

If the superficial lymph nodes are involved, the cure rate drops to 40%.

If the pelvic lymph nodes are involved the cure rate drops to only 20%.

A Family Doctor's Tale - BED SORES

DOC I HAVE BEDSORES

A bed sores is skin which is damaged most commonly by
ischemic necrosis(lack of blood supply leading to breakdown of tissue cells) and ulceration of tissues overlying a bony prominence that has been subjected to prolonged pressure against an external object.

This typically occurs in a incapacitated person lying over a prolonged periods in bed hence the term bed sores.

Blood supply is impaired as a result of constant pressure on the blood vessel resulting in localized gangrene(death of tissue due to lack of blood supply)

The following are considered when determining the severity of the bed sores:

1.Degree of bed sores
2.Extent of the bed sores
3.Age of patient
4.Location of bed sores
5.Other illnesses and injuries

There are 6 stages of a bed sores:

First stage bed sores:
superficial redness of the skin

Second stage bed sores:
The skin is red, hot, swollen with induration. blister formation and desquamation(dropping of skin layer).
There may be some pain

Third stage bed sores:
The full thickness of the skin is damaged with ulceration.

Fouth stage bed sores:
The skin damage extends to the muscle often causing pain because of impingement on the nerve

Fifth stage bed sores:
The necrosis of skin tissue affects the muscles and fat tissue

Sixth stage bed sores:
There is associated bone destruction , bone or joint infection and septicemia(infection of the blood)

Illnesses such as those below can aggravate the severity of the bed soress and affect the healing:
1.Respiratory diseases
2.Diabetes
3.Heart disease
4.Injuries like fractures

Complications of bed sores are:
1.Septicemia or blood infection

2.Cellulitis or abscess formation

Treatment of bed sores:
In the early stage such as redness of the skin, prevention is the best treatment:
1.Encourage regular movement of the body every 2 hours

2.In cases of paralyzed or unconscious patients change position of the patients every 2 hours.

3.apply talcum powder or  soothing cream or lotion on the skin

4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.

5.Painkillers may be necessary for pain.

6.Regular inspection of the skin for cleanliness and dryness.

7. Use of water beds, ripple mattress, inflatable rings, protective padding and Stryker frame for those with spinal cord paralysis all help to prevent bed sores.

More severe cases may need to be treated in a hospital:
1.the bed sores  gets infected(fever, pus formation and increasing pain, redness and swelling).

2.Appropriate antibiotics to treat infection

3.Hydrophilic beads of dextronomer may be useful to clean oozing lesions and promote granulation and recovery

4.Regular debridement(removal of infected tissues) with enzymatic digestive agents

5.In severe cases surgical debridement and skin grafts may be necessary.

6.Underlying medical illnesses such as diabetes, heart attack and stroke should be treated

Prognosis:
In early stage the prognosis is good with preventive measures.

Once ulcers are formed the prognosis is fair.

A Family Doctor's Tale -HYPERKALEMIA

DOC I HAVE HYPERKALEMIA

Hyperkalemia is defined as high Potassium in the blood.

Normal blood potassium varies from 3.4 to 5.7 mmol per liter.
Extracellular potassium level represents only 2 per cent of the total body potassium.

Potassium is a major determinent of intracellular volume of cells and intracellur osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular potassium concentrations.

Plasma and extracellular potassium levels are influenced by many factors particularly acid based balance. Acidosis moves potassium out of cells while alkalosis shifts potassium into cells.

Hyperkalemia occurs with impaired renal function

Symptoms of Hyperkalemia:
1.cardiac arrhythmias

2.muscle weakness especially peripheral muscles

Diagnosis:
1.Plasma potassium levels

2.Electrocardogram shows peaked T waves, prolonged PR intervals,
complete heart block and atrial asystole

Treatment:
1.glucose with insulin infusion  can drives potassium into cells lowering the plasma potassium( U insulin for every 2gms of glucose)

2.Infusion of sodium bicarbonate to induce alkalosis

3.Infusion of calcium bicarbonate to induce alkalosis

4.administer potassium binding resins by mouth

5.hemodialysis

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

A Family Doctor's Tale -HYPOKALEMIA

DOC I HAVE HYPOKALEMIA

Hypokalemia is defined as low Potassium in the blood.

Normal blood potassium varies from 3.4 to 5.7 mmol per liter.
Extracellular potassium level represents only 2 per cent of the total body potassium.

Potassium is a major determinent of intracellular volume of cells and intracellur osmolarity.
It is a also an important cofactor in many metabolic processes.
The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular potassium concentrations.

Plasma and extracellular potassium levels are influenced by many factors particularly acid based balance. Acidosis moves potassium out of cells while alkalosis shifts potassium into cells.

Hypokalemia occurs with gastrointestinal or urinary loss especially following use of potassium wasting diuretics or in diabetes mellitus.

Symptoms of hypokalemia:
1.lethargy

2.generalized fatigue

3.muscle weakness

4.polyuria

5.myocardial irritabilty is increased with hypokalemia and the use of digitalis becomes more dangerous.

Diagnosis:
1.Plasma potassium levels

2.Electrocardogram shows flattening of the T waves, U waves and sagging ST segment

Treatment:
1.oral potassium is given in most cases with improvement of blood potassium level

2.Intravenous potassium is given in emergency cases. The concentration of infused potassium should not exceed 40 mEQ per liter except in rare cases.

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

A Family Doctor's Tale - UNDESCENDED TESTES

DOC I HAVE UNDESCENDED TESTES

Undescended Testis is incomplete or improper descent of one or both testes through the  canal which is the tunnel which leads the spermatic duct from the abdomen to the testis.

The causes of  Undescended Testis are:
1.Normally the testes in the fetus are in the abdomen and make their way to the inguinal canal by the 23rd week of pregenancy and enter the scrotum by the 39th week of pregnancy.

2.Sometimes one or rarely both testes fail to enter the scrotum before birth.They may remain in the abdomen or may be not fully descended to the scrotum at birth.

3.The undescended testes can either be normal or dyplastic(cells may turn abnormal)

4.Intra-abdominal testes may be unable to produce sperm and also susceptible to malignant change.

5.Testis situated outside the usual course of descent is termed ectopic.

Diagnosis:
All male babies are examined at birth to determine whether their testes have descended into the scrotum normally.

Where the testes are not found in the scrotum an ultrasound scan of the pelvis can determine where the testes are located.

Where there is no testes to be found, a human chorionic gonadotrophin test help to rule out anorchia(complete absence of testes) and whether there is a need for counseling later on at puberty.

The complications for Undescended Testis are:
Untreated undescended testes may have increased risk for

1.infertility

2.testicular torsion

3.malignant change

The treatment of Undescended Testis is:
1.In the absence of both testes, there is nothing that can be done.

2.If there is one Undescended Testis, the testis can be brought down to their scrotum.
Similarly if both testes are undescended the testes can be brought down to the scrotum by surgery.

This surgery is preferably done between 2 to five years old.

3.If there is associated indirect inguinal hernia that should be repaired simultaneously.

4.In some cases descent of the testes may occur up to the 3rd month of age.So hypermobile testes found at birth are observed if they can descend by themselves by that age.

The Prognosis of Undescended Testis is:
Most cases of Undescended Testis usually will recover with proper surgical treatment.

If there is bilateral occurence of undescended testes and test shows that they are intra-abdominal, there is high risk of subfertility or sterilty.

Even a single viable testis can have good prognosis for fertility.

Very rarely there may be complications such as postoperative infections or recurrence.

A Family Doctor's Tale - PREMENSTRUAL TENSION

DOC I HAVE PREMENSTRUAL SYNDROME

Premenstrual syndrome is a condition occurring seven to ten days before menses more common in women over the age of 30.

Premenstrual Syndrome may manifested itself as a period of irritability, abdominal discomfort, headache and other various symptoms for the patient presenting just before the menses.

The cause of Premenstrual Syndrome is still not known.
There are a few theories:
1.Fluctuation in estrogen and progesterone hormonal concentration may affect the body's function and emotions

2.The fluid retention action of estrogen may cause abdominal discomfort, irritability of the brain, and weight gain

3.changes in the other glands such as the adrenal gland may also be involved

4.Stress aggravates the symptoms of excessive hormones before the menses.

Symptoms of Premenstrual syndrome may consists of:
1.feeling of fullness in lower abdomen


2.Bloated abdomen and ankle edema(swelling due to fluid retention)


3.Weight gain during the second half of menstrual cycle due to fluid retention which is reversed after the onset of menses


4.Low back pain


5.headache and exacerbation of migraine,


6.painful breasts,


7.depression, anxiety, irritabilty


8.emotional instabilty and mood changes


9.interpersonal problems and social unhappiness

Treatment for premenstrual Syndrome are as follows:


Mild premenstrual Syndrome symptoms:
reassurance without other treatment

More severe Premenstrual syndrome symptoms:
1.ankle edema may require diuretics to pass out fluids or decreased salt intake

2.Tranquillizer or antidepressant for anxiety or depression

3.Analgesics or Muscle relaxant for headaches and back pain

4.breast support with properly fitting brassieres for painful breasts

Very severe symptoms:
a course of low combination female hormones may help

Family counseling may be indicated

Prognosis of Premenstrual syndrome:
It may improve spontaneously over years or it may recur on and off until menopause.

A Family Doctor's Tale - ADDISON DISEASE

DOC I HAVE ADDISON DISEASE

Addison Disease is a  disease which is caused by the deficiency of  circulating glucocorticoids steroids and mineralocorticoids (aldosterone) hormones as a result of disease of the adrenal glands.

The causes are believed to be:
1. Auto-immune disease of the adrenals with destruction of the adrenal parenchyma is associated with circulating antibodies and decreased production of glucocorticosteroids.

2.Tuberculosis of the adrenal glands

3.Adrenal tumors which may be benign or malignant can reduce production of corticosteroids.

4.Rare causes are metastatic carcinoma, amyloidosis and hemachromatosis

5.Iatrogenic -sudden cessation of chronic corticosteroids or failure to increase therapy in corticosteroid dependent patients undergoing stress, surgery or infection.

Symptoms of Addison Disease are:

A.Acute Addison Crisis
The symptoms are :
1.vomiting


2.abdominal pain


3.back and extremity pain


4.extreme muscle weakness


5.dehydration leading to hypotension


6.shock


7.confusion


8.coma


Addison crisis is fortunately rare

B.Chronic Addison disease:
1.Chronic adrenal hypofunction begins gradually

2.fatique

3.loss of appetite and weight

4.abdominal pain.

5.vomiting

6.dizziness

7.craving for salty food

8.increased pigmentation especially palmar flexures, nipples, genitalia, mouth lining, scars and exposed areas.

9.postural hypotension is common with giddiness

10.occasionally hypoglycemic symptoms may occur in early morning or when a meal is missed

Diagnosis of Addison Disease:
1.The increased pigmentation and loss of weight can suggest the diagnosis of Addison Disease

2.Electrolytes especially sodium is low, potassium and urea nitrogen is high

3.ACTH stimulation test with impaired corticol response is required to confirm diagnosis

4.Plasma adrenal antibodies may be present

5.Chest and abdominal X-rays for tuberculosis

Complications of Addison Disease:
1.coma from Addison's crisis

2.Hypotension

Treatment of Addison Disease:
1.Addison crisis is treated by intravenous normal saline and hydrocortisone 100mg every eight hours
Treatment must be done before laboratory confirmation of
diagnosis because of the danger of coma

2.Chronic Addison disease requires replacement of glucocorticoid:
a.hydrocortisone 30mg daily or
b.cortisone acetate 37.5 mg daily or
c.fludrocortisone 0.05 to 0.2 mg daily

Prognosis of Addison Disease:
The prognosis of Addison Disease is usually very good.

Addison crisis patients have excellent recovery with appropriate treatment

Chronic Addison disease patients also recovered well with replacement therapy.

Care is needed when there is trauma, infection and surgery.

A Family Doctor's Tale - CUSHING SYNDROME

DOC I HAVE CUSHING SYNDROME

Cushing Syndrome is a  disease which is caused by the exposure of the body to excessive quantities of glucocorticoids steroids.

People of all ages are affected but more are seen in females between 30 to 50 years of age.

The causes are believed to be:
1. Cushing Disease -excessive production of adrenocorticotrophin hormone(ACTH) by the pituary gland causes bilateral adrenal(gland above kidney)hyperplasia(overgrowth of gland tissue).The enlarged adrenal gland will produce excessive corticosteroids.
A pituitary basophil or chromphobe adenoma may be present.

2.Adrenal tumors which may be benign or malinant can produce excessive corticosteroids

3.Ectopic ACTH syndrome
Production of ACTH by a tumor such as cancer of the lungd leads to adrenal hyperplasia

4.Iatrogenic -patients receiving excessive doses of corticosteroids may present as Cushing syndrome

Symptoms of Cushing Syndrome:
1.Obesity predominally truncal often with pad of fat between shoulders(buffalo hump)

2.Round flat plethoric(red) face (moon face)

3.Skin is thin and bruises easily

4.Purole striae on abdomen, thighs, and shoulders.

5.Proximal myopathy leads to difficulty in getting out of chairs and walking upstairs

6.Excessive adrenal androgen secretions leads to hirsutism, amenorrhea and acne

7.Osteoporis can lead to back pain

8.Hypertension and glycosuria(glucose in urine) are common

9.Depression and other psychiatric disturbance common

10.In children there may stunting of growth

Diagnosis of Cushing Syndrome:
1.The typical moon face and buffalo hump can suggest the diagnosis of Cushing Syndrome

2.24 hour urine cortisol tests

3.Overnight dexamethasone suppression test

4.Plasma ACTH level

5.Chest X-ray to exclude lung cancer

6.X-ray of pituitary fossa to exclde pituitary tumors

7.Ultrasound of adrenal glands for enlargement

Complications of Cushing Syndrome:
1.Hypertension

2.fractures from osteoporosis

3.stunted growth in children

Treatment of Cushing Syndrome:
1.Anti-sdrenal drug such as aminogluthemide

2.bilateral adrenalectomy

3.Surgery to remove pituitary tumor

4.surgery to remove primary neoplasm in lungs or pancreas

Prognosis of Cushing Syndrome:
The prognosis of Cushing Syndrome varies with cause.

The response is often excellent in cases of pituitary tumor removal. However recurrence of tumor or increase in size of the tumor will affect the prognosis.

Benign adrenal tumors have excellent response to treatment.

Iatrogenic Cushing syndrome often responds well to decreasing doses of corticosteroids.

In cases of lung cancer, treatment may have poor response.

A Family Doctor's Tale - NEPHROTIC SYNDROME

DOC I HAVE NEPHROTIC SYNDROME

Nephrotic Syndrome is a rare disease characterized by the edema(accumulation of fluid in the body) and hypo-albumemia (low blood protein due to protein loss through the kidneys).

The cause is the increased capillary permeability of the glomeruli to plasma protein  due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.

Loss of negative charges on the filtering membrane allows negatively charged molecules including albumin to enter the urinary tract.

Reduced protein in the blood leads to edema.

There are 3 types of Nephrotic Syndrome:
1.Minimal Change Nephropathy (MCN) occurs in children with very little microscopic changes in the glomerular tissues of the kidney.

2.Focal glomerulonephritis has appearance of MCN above but develop sclerosis of the glomeruli later.

3.Diffuse proliferative glomerulonephritis and membranous nephropathy are more common in adults and be secondary to other diseases such as:


a.SLE and other connective tissues
b.diabetes
c.allergies to drugs such as penicillinamine, tolbutamide, probenecid
d.certain infections
e.cancer (carcinomas and lymhomas)

Symptoms:
1.Urine may show the presence of protein at least 3.5g/day

2.low protein in blood causes decreased plasma mass pressure resulting in retention of water and salts

3.swelling of the face and ankle occurs as a result

4.edema ranges from puffiness of eyes, ascites (water in abdominal cavity), pleural effusions(water in the lungs) to generalized edema

5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.

6.high blood pressure may occur in one third of patients

7.The blood in nephrotic syndrome tend to clot easily and the patient may develop blood clots in his leg veins.

8.Lipids may be raised in the blood especially triglicerides and cholesterol

9.Symptoms and signs of underlying diseases such as diabetes, SLE etc may be present

Diagnosis:
1.A history of recent kidney infection followed by swelling of face ang legs

2.Urinary protein loss of 15g per day

3.Full examination of fresh urine for red blood cells and casts(indicating glomerulonephritis) and lipid

4.Full blood count and tests for kidney function

5.Ultrasound of kidneys

6.Biopsy of kidney and histology of specimen

Complications:
1.Renal failure

2.hemolytic uremic stndrome

Treatment should be in hospital:
1.Minimal change nephropathy in children are treated with high doses of corticosteroids up to 1mg prednisolone per kg per day.
In most cases within 10 days there should be reduction of fluid in the body with increased urinary passage of urine.
Relapses may occur and should be treated with more corticosteroids or cyclophosphamide

2.In adults treatment with corticosteroids should help to treat the edema.

3.In addition thiazide diuretics or frusemide to reduce edema.
Spironolactone and amiloride may also help

4.Hypertension may require anti hypertensive. The use of corticosteroids may aggravate hypertension.

5.Diet with low salt and protein

6.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids

Prognosis:
1.In most cases of MCN the illness will clear up with proper treatment.

Some may have relapses.

After 3 years of remission 99% of MCN will not have relapses
MCN cases seldom progress to renal failure.

2.In focal glomerulonephritis cases nephrotic syndrome may develop into chronic renal failure.

3.In Membranous nephropathy
25% complete remission
25% improves in renal function
25% have persistent nephrotic syndrome
25% will have chronic renal failure

A Family Doctor's Tale -GLOMERULONEPHRITIS

DOC I HAVE GLOMERULONEPHRITIS

Glomerulonephritis is a disease characterized by the inflammation of the glomeruli, the filtering units of the kidneys.

The glomeruli are unable to function properly due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.

Both kidneys are affected usually.

It is not contagious.

The exact cause of Glomerulonephritis is not known.

1.It has been suggested that an autoimmune disease is the main cause of Glomerulonephritis disease.

The antibodies produced by the body to fight germs starts to attack the body's own healthy kidney tissue.

2.Sometimes Glomerulonephritis disease may follow an infection by the streptococcus bacteria or by viruses.

Symptoms of Glomerulonephritis disease:
1.Urine may show the presence of protein, red blood cells, casts.

2.less urine is passed than normal

3.swelling of the face and legs is quite common

4.high blood pressure may occur in rare cases

5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.

Diagnosis of Glomerulonephritis disease is made by:

1.A history of recent infection followed by swelling of face and legs

2.Urine test for blood, protein and casts

3.Full blood count and tests for kidney function

4.Blood Tests for raised ESR,  anti-streptolysin titer, C reactive protein

5.Ultrasound of kidneys

6.Biopsy of kidney if required

Complications of Glomerulonephritis disease are:
1.Nephrotic syndrome

2.hemolytic uremic syndrome

3.renal failure

Treatment of Glomerulonephritis disease is by:
1.Diet with low salt and protein

2.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids

3. antibiotics are given if the glomerulonephritis is suspected to be caused by a bacteria

4.hypertension is usually controlled with drugs until the blood pressure returns to normal

5.Corticosteroids and cytotoxic drugs have not been found to be effective against glomerulonephritis

Prognosis of Glomerulonephritis disease:
In most cases the illness will clear up with proper treatment.

In rare cases nephrotic syndrome may develop with ensuing chronic renal failure.

A Family Doctor's Tale - THREADWORMS

DOC I HAVE THREADWORMS


Thread worms are parasitic worms (also called pin worms) which are found in the intestines of children in undeveloped countries.

It is rare in developed countries because of the modern sanitary conditions and better hygiene.

Several members of the same household may be infested at the same time so all the family should be treated together.

The cause of Threadworms infection is:
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations.

When the eggs or larvae are swallowed  they developed into adult worms in the intestines.

The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.


The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.

The main symptoms of Thread worms are
1. Itch in the anal region especially at night when the worms lay the eggs.

2. Itch in the vulva in girls

3. inflammation of the anus as a result of constant scratching.

4.Rarely tiny white worms can be seen wriggling in the feces.

Doctors generally diagnose Thread worms based on:

1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of thread worms

2.Stool examination and culture

Treatment of thread worm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose

2.Pyrantel pamoate 10mg/kg in a single dose

3.Mebendazole 100mg in a single dose

A single dose will usually cure the patient of thread worms but to prevent re-infection a second dosage is taken 2 weeks later.

All the family members should also be treated.

Prevention of thread worms is through:
1.good personal hygiene and hand washing

2. good food hygiene

Prognosis of thread worms treatment is excellent.